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Nazli A, Tao W, You H, He X, He Y. Treatment of MRSA Infection: Where are We? Curr Med Chem 2024; 31:4425-4460. [PMID: 38310393 DOI: 10.2174/0109298673249381231130111352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/10/2023] [Accepted: 10/10/2023] [Indexed: 02/05/2024]
Abstract
Staphylococcus aureus is a leading cause of septicemia, endocarditis, pneumonia, skin and soft tissue infections, bone and joint infections, and hospital-acquired infections. In particular, methicillin-resistant Staphylococcus aureus (MRSA) is associated with high morbidity and mortality, and continues to be a major public health problem. The emergence of multidrug-resistant MRSA strains along with the wide consumption of antibiotics has made anti-MRSA treatment a huge challenge. Novel treatment strategies (e.g., novel antimicrobials and new administrations) against MRSA are urgently needed. In the past decade, pharmaceutical companies have invested more in the research and development (R&D) of new antimicrobials and strategies, spurred by favorable policies. All research articles were collected from authentic online databases, including Google Scholar, PubMed, Scopus, and Web of Science, by using different combinations of keywords, including 'anti-MRSA', 'antibiotic', 'antimicrobial', 'clinical trial', 'clinical phase', clinical studies', and 'pipeline'. The information extracted from articles was compared to information provided on the drug manufacturer's website and Clinical Trials.gov (https://clinicaltrials.gov/) to confirm the latest development phase of anti-MRSA agents. The present review focuses on the current development status of new anti-MRSA strategies concerning chemistry, pharmacological target(s), indications, route of administration, efficacy and safety, pharmacokinetics, and pharmacodynamics, and aims to discuss the challenges and opportunities in developing drugs for anti-MRSA infections.
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Affiliation(s)
- Adila Nazli
- Chongqing Key Laboratory of Natural Product Synthesis and Drug Research, School of Pharmaceutical Sciences, Chongqing University, Chongqing, 401331, China
| | - Wenlan Tao
- Chongqing School, University of Chinese Academy of Sciences (UCAS Chongqing), Chongqing, 400714, China
| | - Hengyao You
- Chongqing Key Laboratory of Natural Product Synthesis and Drug Research, School of Pharmaceutical Sciences, Chongqing University, Chongqing, 401331, China
| | - Xiaoli He
- Chongqing School, University of Chinese Academy of Sciences (UCAS Chongqing), Chongqing, 400714, China
| | - Yun He
- Chongqing Key Laboratory of Natural Product Synthesis and Drug Research, School of Pharmaceutical Sciences, Chongqing University, Chongqing, 401331, China
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2
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Long J, Ying T, Zhang L, Yu T, Wu J, Liu Y, Li X, You G, Zhang L, Bi Y. Discovery of fusidic acid derivatives as novel STING inhibitors for treatment of sepsis. Eur J Med Chem 2022; 244:114814. [DOI: 10.1016/j.ejmech.2022.114814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
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3
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Gontijo AVL, Pereira SL, de Lacerda Bonfante H. Can Drug Repurposing be Effective Against Carbapenem-Resistant Acinetobacter baumannii? Curr Microbiol 2021; 79:13. [PMID: 34905109 PMCID: PMC8669236 DOI: 10.1007/s00284-021-02693-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
Carbapenem-resistant Acinetobacter baumannii has been classified as a top priority for the development of new therapies due to its resistance to most antibiotics. Drug repurposing may be a fast and inexpensive strategy for treating this pathogen. This review aims to critically evaluate repurposed drugs for the treatment of infections caused by carbapenem-resistant A. baumannii, correlating their antimicrobial activity with data available for toxicity and side effects. Some drugs have been suggested as promising candidates for repurposing; however, in some cases, high toxicity and low plasma concentrations reduce applicability in clinical practice. The most favorable applicability is offered by fusidic acid and colistin, possibly combined with a third agent, promising to be well tolerated and achieving satisfactory plasma concentrations.
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Affiliation(s)
- Aline Vidal Lacerda Gontijo
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Juiz de Fora (UFJF), Rua José Lourenço Kelmer, s/n, São Pedro, Juiz de Fora, Minas Gerais, 36036-900, Brazil.
| | - Sharlene Lopes Pereira
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Juiz de Fora (UFJF), Rua José Lourenço Kelmer, s/n, São Pedro, Juiz de Fora, Minas Gerais, 36036-900, Brazil
| | - Herval de Lacerda Bonfante
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Juiz de Fora (UFJF), Rua José Lourenço Kelmer, s/n, São Pedro, Juiz de Fora, Minas Gerais, 36036-900, Brazil
- Division of Rheumatology, Hospital Santa Casa de Misericórdia de Juiz de Fora (SCMJF), Juiz de Fora, Minas Gerais, Brazil
- Department of Internal Medicine, School of Medical Sciences, Health of Juiz de Fora (SUPREMA), Juiz de Fora, Minas Gerais, Brazil
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4
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Long J, Ji W, Zhang D, Zhu Y, Bi Y. Bioactivities and Structure-Activity Relationships of Fusidic Acid Derivatives: A Review. Front Pharmacol 2021; 12:759220. [PMID: 34721042 PMCID: PMC8554340 DOI: 10.3389/fphar.2021.759220] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/27/2021] [Indexed: 12/22/2022] Open
Abstract
Fusidic acid (FA) is a natural tetracyclic triterpene isolated from fungi, which is clinically used for systemic and local staphylococcal infections, including methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci infections. FA and its derivatives have been shown to possess a wide range of pharmacological activities, including antibacterial, antimalarial, antituberculosis, anticancer, tumor multidrug resistance reversal, anti-inflammation, antifungal, and antiviral activity in vivo and in vitro. The semisynthesis, structural modification and biological activities of FA derivatives have been extensively studied in recent years. This review summarized the biological activities and structure-activity relationship (SAR) of FA in the last two decades. This summary can prove useful information for drug exploration of FA derivatives.
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Affiliation(s)
- Junjun Long
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, China
| | - Wentao Ji
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, China
| | - Doudou Zhang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, China
| | - Yifei Zhu
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, China
| | - Yi Bi
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, China
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5
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Garcia Chavez M, Garcia A, Lee HY, Lau GW, Parker EN, Komnick KE, Hergenrother PJ. Synthesis of Fusidic Acid Derivatives Yields a Potent Antibiotic with an Improved Resistance Profile. ACS Infect Dis 2021; 7:493-505. [PMID: 33522241 DOI: 10.1021/acsinfecdis.0c00869] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fusidic acid (FA) is a potent steroidal antibiotic that has been used in Europe for more than 60 years to treat a variety of infections caused by Gram-positive pathogens. Despite its clinical success, FA requires significantly elevated dosing (3 g on the first day, 1.2 g on subsequent days) to minimize resistance, as FA displays a high resistance frequency, and a large shift in minimum inhibitory concentration is observed for resistant bacteria. Despite efforts to improve on these aspects, all previously constructed derivatives of FA have worse antibacterial activity against Gram-positive bacteria than the parent natural product. Here, we report the creation of a novel FA analogue that has equivalent potency against clinical isolates of Staphylococcus aureus (S. aureus) and Enterococcus faecium (E. faecium) as well as an improved resistance profile in vitro when compared to FA. Importantly, this new compound displays efficacy against an FA-resistant strain of S. aureus in a soft-tissue murine infection model. This work delineates the structural features of FA necessary for potent antibiotic activity and demonstrates that the resistance profile can be improved for this scaffold and target.
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Affiliation(s)
- Martin Garcia Chavez
- Department of Chemistry, University of Illinois at Urbana−Champaign, Roger Adams
Laboratory, 600 South Mathews Avenue, Urbana, Illinois 61801, United States
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Alfredo Garcia
- Department of Chemistry, University of Illinois at Urbana−Champaign, Roger Adams
Laboratory, 600 South Mathews Avenue, Urbana, Illinois 61801, United States
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Hyang Yeon Lee
- Department of Chemistry, University of Illinois at Urbana−Champaign, Roger Adams
Laboratory, 600 South Mathews Avenue, Urbana, Illinois 61801, United States
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Gee W. Lau
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois at Urbana−Champaign, 2001 South Lincoln Avenue, Urbana, Illinois 61801, United States
| | - Erica N. Parker
- Department of Chemistry, University of Illinois at Urbana−Champaign, Roger Adams
Laboratory, 600 South Mathews Avenue, Urbana, Illinois 61801, United States
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Kailey E. Komnick
- Department of Chemistry, University of Illinois at Urbana−Champaign, Roger Adams
Laboratory, 600 South Mathews Avenue, Urbana, Illinois 61801, United States
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
| | - Paul J. Hergenrother
- Department of Chemistry, University of Illinois at Urbana−Champaign, Roger Adams
Laboratory, 600 South Mathews Avenue, Urbana, Illinois 61801, United States
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61801, United States
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6
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Njoroge M, Kaur G, Espinoza-Moraga M, Wasuna A, Dziwornu GA, Seldon R, Taylor D, Okombo J, Warner DF, Chibale K. Semisynthetic Antimycobacterial C-3 Silicate and C-3/C-21 Ester Derivatives of Fusidic Acid: Pharmacological Evaluation and Stability Studies in Liver Microsomes, Rat Plasma, and Mycobacterium tuberculosis culture. ACS Infect Dis 2019; 5:1634-1644. [PMID: 31309823 DOI: 10.1021/acsinfecdis.9b00208] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Fusidic acid (FA), a natural product fusidane triterpene-based antibiotic with unique structural features, is active in vitro against Mycobacterium tuberculosis, the causative agent of tuberculosis (TB). While possessing good pharmacokinetics in man, FA is rapidly metabolized in rodents, thus complicating proof-of-concept studies in this model. Toward the repositioning of FA as an anti-TB agent, we herein describe the synthesis, activity, and metabolism of FA and semisynthesized ester derivatives in rat liver microsomes, rat plasma, and mycobacterial cell culture. FA and derivative molecules with a free C-3 OH underwent species-specific metabolism to the corresponding 3-OH epimer, 3-epifusidic acid (3-epiFA). FA was also metabolized in rat plasma to form FA lactone. These additional routes of metabolism may contribute to the more rapid clearance of FA observed in rodents. C-3 alkyl and aryl esters functioned as classic prodrugs of FA, being hydrolyzed to FA in microsomes, plasma, and Mycobacterium tuberculosis culture. In contrast, C-3 silicate esters and C-21 esters were inert to hydrolysis and so did not act as prodrugs. The antimycobacterial activity of the C-3 silicate esters was comparable to that of FA, and these compounds were stable in microsomes and plasma, identifying them as potential candidates for evaluation in a rodent model of tuberculosis.
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Affiliation(s)
- Mathew Njoroge
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa
| | - Gurminder Kaur
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa
| | | | - Antonina Wasuna
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa
| | | | - Ronnett Seldon
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
- Drug Discovery and Development Centre (H3D), University of Cape Town, Rondebosch 7701, South Africa
| | - Dale Taylor
- Drug Discovery and Development Centre (H3D), University of Cape Town, Rondebosch 7701, South Africa
| | - John Okombo
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa
| | - Digby F. Warner
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
- SAMRC/NHLS/UCT Molecular Mycobacteriology Research Unit, DST/NRF Centre of Excellence for Biomedical TB Research, Department of Pathology and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch 7701, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Rondebosch 7701, South Africa
| | - Kelly Chibale
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
- Drug Discovery and Development Centre (H3D), University of Cape Town, Rondebosch 7701, South Africa
- South African Medical Research Council Drug Discovery and Development Research Unit, University of Cape Town, Rondebosch 7701, South Africa
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7
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Lin XX, Lian GH, Xu Y, Zhao Q, Xiao J, Peng SF, Xiao MF, Ouyang DS, Tan ZR, Wang YC, Peng JB, Zhang W, Chen Y. The potent mechanism-based inactivation of CYP2D6 and CYP3A4 with fusidic acid in in vivo bioaccumulation. Xenobiotica 2017; 48:999-1005. [PMID: 29027845 DOI: 10.1080/00498254.2017.1390628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
1. The accumulation of fusidic acid (FA) after multiple doses of FA has been reported on in previous studies but the related mechanisms have not been clarified fully. In the present study, we explain the mechanisms related to the mechanism-based inactivation of CYP2D6 and CYP3A4. 2. The irreversible inhibitory effects of FA on CYP2D6 and CYP3A4 were examined via a series of experiments, including: (a) time-, concentration- and NADPH-dependent inactivation, (b) substrate protection in enzyme inactivation and (c) partition ratio with recombinant human CYP enzymes. Metoprolol α-hydroxylation and midazolam 1'-hydroxylation were used as marker reactions for CYP2D6 and CYP3A4 activities, and HPLC-MS/MS measurement was also utilised. 3. FA caused to the time- and concentration-dependent inactivation of CYP2D6 and CYP3A4. About 55.8% of the activity of CYP2D6 and 75.8% of the activity of CYP3A4 were suppressed after incubation with 10 μM FA for 15 min. KI and kinact were found to be 2.87 μM and 0.033 min-1, respectively, for CYP2D6, while they were 1.95 μM and 0.029 min-1, respectively, for CYP3A4. Inhibition of CYP2D6 and CYP3A4 activity was found to require the presence of NADPH. Substrates of CYP2D6 and CYP3A4 showed that the enzymes were protected against the inactivation induced by FA. The estimated partition ratio for the inactivation was 7 for CYP2D6 and 12 for CYP3A4. 4. FA is a potent mechanism-based inhibitor of CYP2D6 and CYP3A4, which may explain the accumulation of FA in vivo.
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Affiliation(s)
- Xiu-Xian Lin
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Guang-Hui Lian
- c Department of gastroenterology , Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - Ying Xu
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Qing Zhao
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Jian Xiao
- d Department of Pharmacy , Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - Shi-Fang Peng
- e Department of Hepatology and Infectious Diseases , Xiangya Hospital, Central South University , Changsha , Hunan , China , and.,f Health Management Center, Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - Mei-Fang Xiao
- e Department of Hepatology and Infectious Diseases , Xiangya Hospital, Central South University , Changsha , Hunan , China , and.,f Health Management Center, Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - Dong-Sheng Ouyang
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Zhi-Rong Tan
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Yi-Cheng Wang
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Jing-Bo Peng
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Wei Zhang
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Yao Chen
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
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8
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Gustinetti G, Cangemi G, Bandettini R, Castagnola E. Pharmacokinetic/pharmacodynamic parameters for treatment optimization of infection due to antibiotic resistant bacteria: a summary for practical purposes in children and adults. J Chemother 2017; 30:65-81. [PMID: 29025364 DOI: 10.1080/1120009x.2017.1377909] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In the last years, there has been a tremendous increase in the incidence of bacterial infections due to resistant strains, especially multi-drug resistant Gram-negative bacilli. In Europe, a north to south and a west to east gradient was noticed, with more than one third of the K. pneumonia isolates being resistant to carbapenems in few countries. New antibiotics are lacking and, as a consequence, pharmacokinetic/pharmacodynamic parameters, normalized to pathogen minimal inhibitory concentration, are used with increased frequency to treat infections due to difficult-to-treat pathogens. These parameters are available at least for the adult population, but sparse in many different publications. This review wants to provide a comprehensive and 'easy to read' text for everyday practice, briefly summarizing the presently available knowledge on pharmacokinetic/pharmacodynamic parameters (normalized for minimal inhibitory concentration values) of different class drugs, that can be applied for an effective antibacterial treatment infections due to antibiotic-resistant pathogens.
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Affiliation(s)
- Giulia Gustinetti
- a Department of Infectious Diseases , University of Genoa , Genoa , Italy
| | - Giuliana Cangemi
- b Istituto Giannina Gaslini, Children's Hospital , Genoa , Italy
| | | | - Elio Castagnola
- b Istituto Giannina Gaslini, Children's Hospital , Genoa , Italy
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9
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Chen D, Lin XX, Zhao Q, Xiao J, Peng SF, Xiao MF, Ouyang DS, Tan ZR, Wang YC, Peng JB, Zhang W, Chen Y. Screening of drug metabolizing enzymes for fusidic acid and its interactions with isoform-selective substrates in vitro. Xenobiotica 2016; 47:778-784. [PMID: 27571049 DOI: 10.1080/00498254.2016.1230795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
1. Fusidic acid (FA) is widely used for the treatment of infections of sensitive osteomyelitis or skin and soft tissue caused by bacteria. However, the role of cytochrome P450s (CYPs) in the metabolism of FA is unclear. In the present study, we screened the main CYPs for the metabolism of FA and studied its interactions with isoform-selective substrates in vitro. 2. The main CYP450s were screened according to the inhibitory effect of specific inhibitors on the metabolism of FA in human liver microsomes (HLMs) or recombinant CYP isoforms. Enzyme kinetic parameters including Ki, Ki', Vmax, and IC50 were calculated to determine the potential of FA to affect CYP-mediated metabolism of isoform-selective substrates. 3. FA metabolism rate was inhibited by 49.8% and 83.1% under CYP2D6, CYP3A4 selective inhibitors in HLMs. In recombinant experiment, the inhibitory effects on FA metabolism were 83.3% for CYP2D6 and 58.9% for CYP3A4, respectively. FA showed inhibition on CYP2D6 and CYP3A4 with Kis of 13.9 and 38.6 μM, respectively. Other CYP isoforms including CYP1A2, CYP2A6, CYP2C9, CYP2E1, and CYP2C19 showed minimal or no effect on the metabolism of FA. 4. FA was primarily metabolized by CYP2D6 and CYP3A4 and showed a noncompetitive inhibition on CYP2D6 and a mixed competitive inhibition on CYP3A4. Drug-drug interactions between FA and other chemicals, especially with substrates of CYP2D6 and CYP3A4, are phenomena that clinicians need to be aware of and cautious about.
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Affiliation(s)
- D Chen
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - X-X Lin
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Q Zhao
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - J Xiao
- c Department of Pharmacy , Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - S-F Peng
- d Department of Hepatology and Infectious Diseases , Xiangya Hospital, Central South University , Changsha , Hunan , China , and.,e Health Management Center, Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - M-F Xiao
- d Department of Hepatology and Infectious Diseases , Xiangya Hospital, Central South University , Changsha , Hunan , China , and.,e Health Management Center, Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - D-S Ouyang
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Z-R Tan
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Y-C Wang
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - J-B Peng
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - W Zhang
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
| | - Y Chen
- a Department of Clinical Pharmacology , Xiangya Hospital, Central South University , Changsha , Hunan , China.,b Institute of Clinical Pharmacology, Central South University , Changsha , Hunan , China
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10
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Lapham K, Novak J, Marroquin LD, Swiss R, Qin S, Strock CJ, Scialis R, Aleo MD, Schroeter T, Eng H, Rodrigues AD, Kalgutkar AS. Inhibition of Hepatobiliary Transport Activity by the Antibacterial Agent Fusidic Acid: Insights into Factors Contributing to Conjugated Hyperbilirubinemia/Cholestasis. Chem Res Toxicol 2016; 29:1778-1788. [DOI: 10.1021/acs.chemrestox.6b00262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | - Shuzhen Qin
- Biological
Screening and Assay Development, Cyprotex, Watertown, Massachusetts 02472, United States
| | - Christopher J. Strock
- Biological
Screening and Assay Development, Cyprotex, Watertown, Massachusetts 02472, United States
| | | | | | | | | | | | - Amit S. Kalgutkar
- Pharmacokinetics,
Dynamics, and Metabolism Department, Pfizer Worldwide Research and Development, Cambridge, Massachusetts 02139, United States
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11
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Pushkin R, Iglesias-Ussel MD, Keedy K, MacLauchlin C, Mould DR, Berkowitz R, Kreuzer S, Darouiche R, Oldach D, Fernandes P. A Randomized Study Evaluating Oral Fusidic Acid (CEM-102) in Combination With Oral Rifampin Compared With Standard-of-Care Antibiotics for Treatment of Prosthetic Joint Infections: A Newly Identified Drug-Drug Interaction. Clin Infect Dis 2016; 63:1599-1604. [PMID: 27682068 DOI: 10.1093/cid/ciw665] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/14/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Fusidic acid (FA) has been used for decades for bone infection, including prosthetic joint infection (PJI), often in combination with rifampin (RIF). An FA/RIF pharmacokinetic interaction has not previously been described. METHODS In a phase 2 open-label randomized study, we evaluated oral FA/RIF vs standard-of-care (SOC) intravenous antibiotics for treatment of hip or knee PJI. Outcome assessment occurred at reimplantation (week 12) for subjects with 2-stage exchange, and after 3 or 6 months of treatment for subjects with hip or knee debride and retain strategies, respectively. RESULTS Fourteen subjects were randomized 1:1 to FA/RIF or SOC. Pharmacokinetic profiles were obtained for 6 subjects randomized to FA/RIF. FA concentrations were lower than anticipated in all subjects during the first week of therapy, and at weeks 4 and 6, blood levels continued to decline. By week 6, FA exposures were 40%-45% lower than expected. CONCLUSIONS The sponsor elected to terminate this study due to a clearly illustrated drug-drug interaction between FA and RIF, which lowered FA levels to a degree that could influence subject outcomes. Optimization of FA exposure if used in combination with RIF should be a topic of future research. CLINICAL TRIALS REGISTRATION NCT01756924.
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Affiliation(s)
| | | | | | | | - Diane R Mould
- Projections Research Inc, Phoenixville, Pennsylvania
| | | | - Stephan Kreuzer
- Memorial Bone and Joint Clinic and University of Texas Health Science Center at Houston
| | - Rabih Darouiche
- Departments of Medicine, Surgery, and Physical Medicine and Rehabilitation, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
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12
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Eng H, Scialis RJ, Rotter CJ, Lin J, Lazzaro S, Varma MV, Di L, Feng B, West M, Kalgutkar AS. The Antimicrobial Agent Fusidic Acid Inhibits Organic Anion Transporting Polypeptide-Mediated Hepatic Clearance and May Potentiate Statin-Induced Myopathy. Drug Metab Dispos 2016; 44:692-9. [DOI: 10.1124/dmd.115.067447] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/12/2016] [Indexed: 12/19/2022] Open
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Fernandes P. Fusidic Acid: A Bacterial Elongation Factor Inhibitor for the Oral Treatment of Acute and Chronic Staphylococcal Infections. Cold Spring Harb Perspect Med 2016; 6:a025437. [PMID: 26729758 DOI: 10.1101/cshperspect.a025437] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Fusidic acid is an oral antistaphylococcal antibiotic that has been used in Europe for more than 40 years to treat skin infections as well as chronic bone and joint infections. It is a steroidal antibiotic and the only marketed member of the fusidane class. Fusidic acid inhibits protein synthesis by binding EF-G-GDP, which results in the inhibition of both peptide translocation and ribosome disassembly. It has a novel structure and novel mode of action and, therefore, there is little cross-resistance with other known antibiotics. Many mutations can occur in the FusA gene that codes for EF-G, and some of these mutations can result in high-level resistance (minimum inhibitory concentration [MIC] > 64 mg/L), whereas others result in biologically unfit staphylococci that require compensatory mutations to survive. Low-level resistance (<8 mg/L) is more common and is mediated by fusB, fusC, and fusD genes that code for small proteins that protect EF-G-GDP from binding fusidic acid. The genes for these proteins are spread by plasmids and can be selected mostly by topical antibiotic use. Reports of resistance have led to combination use of fusidic acid with rifampin, which is superseded by the development of a new dosing regimen for fusidic acid that can be used in monotherapy. It consists of a front-loading dose to decrease the potential for resistance development followed by a maintenance dose. This dosing regimen is now being used in clinical trials in the United States for skin and refractory bone and joint infections.
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Yu T, Stockmann C, Balch AH, Spigarelli MG, Sherwin CMT. Evolution of interventional vancomycin trials in light of new antibiotic development in the USA, 1999-2012. Int J Antimicrob Agents 2013; 43:215-22. [PMID: 24183801 DOI: 10.1016/j.ijantimicag.2013.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/02/2013] [Indexed: 12/15/2022]
Abstract
Use of vancomycin has increased following the emergence of resistant Gram-positive bacterial infections. Investigation into recent vancomycin clinical studies provides insight into the optimal use of vancomycin and the development of novel antibiotics for the treatment of resistant infections. Interventional vancomycin trials registered in ClinicalTrials.gov from January 1999 to December 2012 were identified. Trial trends and characteristics were evaluated in the context of vancomycin use and new antibiotic development. Overall, 122 interventional vancomycin trials were identified, with a significant increase in the number of registered trials per year (P<0.001). The top three indications studied were skin and soft-tissue infections (28.7%), Clostridium difficile infections (13.1%) and surgical prophylaxis (12.3%). Trials testing vancomycin as an experimental agent differed from trials using vancomycin as an active comparator. Experimental agent trials commonly investigated new formulations, dosing regimen optimisation and combination therapy, which were less likely to be in phase 2 or 3 (25% vs. 70%; P<0.001), adopt a randomisation procedure (70% vs. 98%; P<0.001), report results (15% vs. 35%; P=0.02) or be funded by industry (8% vs. 76%; P<0.001). Active comparator trials mainly focused on monotherapy, which led to six FDA-approved drug products and ten investigational new drugs in late-phase development. This study demonstrated a significant increase in interventional vancomycin trials and its recent success, which resulted in several novel agents against resistant Gram-positive bacteria. Further studies are warranted to determine how these agents can best be incorporated within clinical practice.
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Affiliation(s)
- Tian Yu
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Chris Stockmann
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Alfred H Balch
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Michael G Spigarelli
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Catherine M T Sherwin
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
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Population pharmacokinetics of fusidic acid: rationale for front-loaded dosing regimens due to autoinhibition of clearance. Antimicrob Agents Chemother 2012; 57:498-507. [PMID: 23147726 DOI: 10.1128/aac.01354-12] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The objectives of this analysis were to develop a population pharmacokinetic (PK) model to describe the absorption and disposition of fusidic acid after single and multiple doses and to determine the effect of food on the rate and extent of bioavailability. Plasma PK data from three phase 1 studies (n = 75; n = 14 with and without food) in which healthy subjects received sodium fusidate (500 to 2,200 mg) as single or multiple oral doses every 8 h (q8h) or q12h for up to 7 days were modeled using S-ADAPT (MCPEM algorithm). Accumulation of fusidic acid after multiple doses was more than that predicted based on single-dose data. The PK of fusidic acid was best described using a time-dependent mixed-order absorption process, two disposition compartments, and a turnover process to describe the autoinhibition of clearance. The mean total clearance (% coefficient of variation) was 1.28 liters/h (33%) and the maximum extent of autoinhibition was 71.0%, with a 50% inhibitory concentration (IC(50)) of 46.3 mg/liter (36%). Food decreased the extent of bioavailability by 18%. As a result of the autoinhibition of clearance, steady state can be achieved earlier with dosing regimens that contain higher doses (after 8 days for 750 mg q12h and 1 day for 1,500 mg q12h on day 1 followed by 600 mg q12h versus 3 weeks for 500 mg q12h). Given that large initial doses autoinhibit the clearance of fusidic acid, this characteristic provides a basis for the administration of front-loaded dosing regimens of sodium fusidate which would allow for effective concentrations to be achieved early in therapy.
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Abstract
The resolution of antibiotic-ribosomal subunit complexes and antibacterial-protein complexes at the atomic level has provided new insights into modifications of clinically relevant antimicrobials and provided new classes that target the protein cellular apparatus. New chemistry platforms that use fragment-based drug design or allow novel modifications in known structural classes are being used to design new antibiotics that overcome known resistance mechanisms and extend spectrum and potency by circumventing ubiquitous efflux pumps. This review provides details on seven antibiotics in development for treatment of moderate-to-severe community-acquired bacterial pneumonia and/or acute bacterial skin and skin structure infections: solithromycin, cethromycin, omadacycline, CEM-102, GSK1322322, radezolid, and tedizolid. Two antibiotics of the oxazolidinone class, PF-02341272 and AZD5847, are being developed as antituberculosis agents. Only three antibiotics that target the protein cellular machinery, TP-434, GSK2251052, and plazomicin, have a spectrum that encompasses multidrug-resistant Gram-negative pathogens. These compounds provide hope for treating key pathogens that cause serious disease in both the community and the hospital.
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Affiliation(s)
- Joyce A Sutcliffe
- Tetraphase Pharmaceuticals, Inc., Watertown, Massachusetts 02472, USA.
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Fernandes P, Pereira D. Efforts to Support the Development of Fusidic Acid in the United States. Clin Infect Dis 2011; 52 Suppl 7:S542-6. [DOI: 10.1093/cid/cir170] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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